Tag Archive for: Dr. Peter Schmaus

Ask An Expert: Knee Replacement

Advice From An Orthopedic Physician.

A reader asks:

I need a knee replacement. Is there one implant (Zimmer, Depuy, Stryker, etc.) that is better for returning to skiing?

Here’s the reply from Dr. Peter Schmaus, Orthopedic Spine and Sports, Paramus, NJ:

Thank you for that interesting and timely question. There are nearly 700,000 knee replacements done in the United States annually and that number is increasing. Many  of these adults participate in snow sports and wish to continue skiing. More conservative  orthopedists in the past have advised against skiing with a total knee replacement and especially with a total hip replacement. However there is no clear evidence that  when skiing within limits, a total knee replacement presents a problem. Logically, experienced skiers in good physical condition should fare better.  A novice skier may however present more risk. Reducing impact , perhaps avoiding the bumps and limiting significant knee flexion would be prudent. Cross country skiing should present no problem at all.  Advances in equipment have also contributed to reduced risk.
There is no academic work showing  disproportionate loosening or wear and tear of the prosthesis, and no one brand  of prosthesis to my knowledge is superior to another.
There may be extenuating circumstances in regard to other coexisting orthopedic conditions and participants should asses the risks and benefits with their orthopedist and ideally, work with a physical therapist experienced in snow sports.

Have a question about technique, gear, destinations, travel, or any other aspect of winter sports? Send it to mike@seniorsskiing.com, and we’ll do our best to find an expert to respond.

Focus On Conditioning: Still Time For This Season

[Editor Note: This article was contributed by Peter Schmaus, MD, Orthopedic Spine and Sports Medicine Center, Paramus, NJ. and Senior Attending Physician, Hackensack University Medical Center. SeniorsSkiing.com is very grateful to have his view on conditioning.]

Pay Attention To Body Tuning Before You Hit The Slopes Or Trails.

Many of us pay more attention to our equipment than the most important equipment of all—us! Many ski injuries and overuse syndromes can be avoided by simple preventative maintenance. While sharpening your edges and maintaining bindings are smart, even more important is a musculoskeletal tune up on yourself. This is even more crucial as we age and the musculoskeletal system inevitably displays the wear and tear of the years.

We lose muscle mass annually as we age over 40, but this can be reversed with the correct exercise regimen. Joints inevitably become stiffened both from cartilage thinning as well as tightening of the soft tissues surrounding the joints and spine. These conditions, while not completely reversible, can be managed with exercise programs stressing both flexibility and strengthening.

While stabilization and core are buzzwords frequently used in the fitness field, for snow sports those words cannot be repeated too often. Fitness trainers, therapists, and physicians refer to muscle groups that are core stabilizers. These include the rectus abdominus, external and internal obliques, back extensors, and the pelvic floor muscles.

These are your natural weight lifting belt and lumbar support muscles. They stabilize and support the spine in all planes, and a strong core helps provide balance and force required to carve a turn or navigate a field of moguls. Core muscles even support your spine when pulling off your boots at the end of the ski day. Exercise methods include Swiss ball, back extension, modified crunches, various planks and supermen. All can be done in the home without elaborate gym equipment. And do not forget the simple push up and proper squat.

We frequently refer to the posterior chain, which includes the gluteal muscles, the hamstrings as well as latissimus, and back extensors. Regimens can include lunges, modified dead lifts, squats, kettle bells and burpees. If your bodyweight does not provide sufficient resistance, add some light weight. Simple flat plates, kettle bells, or even resistance bands will suffice. Then move on to side-to-side exercises, which simulate ski motion.  Keeping your center of gravity well centered is the physics behind a good day on the mountain.

Be mindful that snow sports, while not overly aerobic, do require exertion and therefore increased cardiovascular activity. That is aside from the long walk uphill though the parking lot with all your heavy equipment.

Also important especially as we age are balance exercises. Stand on a balance or wobble board. Not a challenge? Hold two light weights. Go through your regimen while remaining balanced on the board. It is not easy in the beginning, but the benefits of enhanced balance and stability are crucial on uneven terrain. Constructing a preventative exercise program well in advance of those first days on the mountain will reduce the risk of injury, making those days on the mountain more enjoyable and injury and pain free.